Frühe Störungen aus der Sicht zunehmender Mentalisierung

The term “mentalization” describes the capacity to judge other humans in terms of their mental activities such as wishes, hopes, beliefs and intentions, as well as the ability to think about one’s own thinking. Mentalization and reflective function are equivalent to each other. They play an important role in selforganization, impulse control, and affect regulation. Mentalization develops during approximately the first five years of life on the basis of attachment in Bowlby’s sense. Around the 9th month of life the child begins to understand her mother as an intentional agent. Mirroring by the mother, in a way of reproducing the child’s state of mind but in a slightly different “marked” manner, enables the child to establish a second “objectified” representation of her condition besides her primary unreflected one. Consequences of lacking, unmarked, or distorted mirroring for later narcissistic or borderline personality are discussed. The child begins now thinking, i.e. playing with representations, but the state of brain development allows to conceive of only one reality. Internal world and external reality appear undistinguishably identical. This is called the “equivalence mode” of psychic functioning. As-if-games open, in a further developmental step, the possibility of including a second reality, namely a pretended one. This is called the “pretend mode” of psychic functioning. At age four to five the child has reached the capacity to take multiple realities into consideration, to take the perspective of an other and to decentrate. She now has a “theory of mind”. Patients with early disturbances have reached this stage only partially. They may also regress to one of the earlier modes of psychic functioning as a consequence of stress or trauma. The knowledge of these early mechanisms helps to identify and understand them when they appear in our clinical practice.     

Increasing Youths’ Participation in Team-Based Treatment Planning: The <Emphasis Type="Italic">Achieve My Plan</Emphasis> Enhancement for Wraparound

Wraparound is a frequently implemented approach for providing individualized, community-based care for children and adolescents with serious mental health conditions and, typically, involvement in multiple child—and family-serving systems. Both Wraparound’s principles and its theory of change stress the importance of youths’ active participation throughout. However, research focusing on the experiences of youth in Wraparound indicates that they are often not particularly engaged in the process or participating actively with their teams, and the findings point to a lack of alliance between the young people and their teams. This article describes a randomized study testing the Achieve My Plan (AMP) enhancement for Wraparound, which is intended to increase young people’s satisfaction, active engagement and self-determined participation in Wraparound, as well as their alliance with the team. Study findings showed that, relative to youth who received “as usual” Wraparound, young people who received Wraparound with the AMP enhancement participated more—and in a more active and self-determined manner—with their teams. They also rated their alliance with their Wraparound teams significantly higher. Furthermore, adult team members in the intervention condition rated team meetings as being more productive, and they were more likely to say that the AMP meetings were “much better than usual” team meetings. Findings support the idea that it is possible—using a low-cost, low-“dose” intervention—to enhance young people’s self-determination and their engagement in Wraparound without detracting from team functioning or the satisfaction of other team members.     

Creating Computer-Mediated Communities of Practice in Special Education

Summary

The convergence of theory and research on socially shared cognition represents a promising new direction for understanding how to enhance the intellectual growth of individuals. In this article, we draw upon the metaphor of “apprenticeship” to explain how individual cognitive development of children and adults alike can be enhanced by mentoring relationships within a particular educational “culture.” The view advanced here is that computers and related technologies can be instrumental in creating socially interactive and reflective learning communities. Within these communities there is active transmission of knowledge between individuals as they are guided from the periphery through to the center of the learning enterprise. Examples of communities of learners are provided to illustrate the process of socially shared cognition and development of knowledge networks. Principles for the creation of sustainable learning communities apply equally to traditional educational settings and on-line communities. The concept of the “collective zone of proximal development” is advanced here to explain how cognitive growth progressively occurs for community members who are operating within a socially interactive and reflective learning environment. Finally, principles and recommendations are offered on how to design communities so that all individuals can achieve their optimal functioning level through guided social participation.     

Adult attachment and perceptions of closeness

An online sample of more than 150,000 participants was used to examine whether—in addition to predicting how much intimacy people want—attachment styles also predict how people define and perceive intimacy. Results indicated that, as compared with relatively secure individuals, people with high levels of attachment anxiety required more time, affection, and self‐disclosure to construe a relationship as “close.” Additionally, anxious individuals perceived less intimacy in relationship vignettes than did their less anxious peers. In contrast, highly avoidant individuals required less time, affection, and self‐disclosure to define a relationship as “close,” and they perceived more intimacy in vignettes than did their more secure peers. These findings indicate that people who are relatively anxious not only want more intimacy in their relationships, but they are also less likely to perceive intimacy, as compared with their less anxious peers. Conversely, people high in avoidance not only want less intimacy, but they are also more sensitive to its presence, as compared with their less avoidant peers.     

How much can you bend before you break: An experience of using constructionist consulting as a tool for organizational learning in the corporate world

This article reflects upon the experience the authors had in the process of designing and facilitating a year-long leadership development class within a division of a high-tech manufacturing corporation in the USA. The design reflected narrative (Simons, 1997; Epston & White, 1990), feminist (Ferguson, 1984; Ramsey & Calvert, 1994), and constructionist principles, and was implemented as a “learning-in-organizing process” (Abma, this issue). We have structured the article to capture the dynamic nature of this process. This includes a discussion of how we as “outsider” class instructors and “insider” participants negotiated and renegotiated the design of the class as well as the effects of these “relational negotiations” on our collective learning. We end with a consideration of the implications of our “learning-in-organizing” for other constructionist consultants (Campbell, Caldicott, & Kinsella, 1994) who are translating organizational learning theories into practice.     

Reflective Parenting Programs: Theory and Development

Recent research has indicated that parental reflective functioning or mentalization plays a crucial role in the development of a range of healthy adaptations in both parent and child. While many parenting interventions developed over the course of the last 20 years have implicitly attempted to enhance mentalization in parents, this article describes an effort to directly intervene with parents to enhance or encourage the development of reflective capacities. In this article, the broad outlines of a reflective parenting approach are described. Two reflective parenting programs are then considered, one a group intervention designed for low-risk parents, the other a home visiting intervention designed for high-risk parents and children.     

Playing Together: DIR and Child Psychodynamic Therapy

ABSTRACT

This article describes the integration of the developmental, individual difference, relationship model (DIR) and relational child psychodynamic therapy. DIR is an effective treatment for many children with uneven development, not only for those on the autistic spectrum. The importance for child psychodynamic therapists to understand individual differences, as delineated by occupational and speech/language therapists, and to include parents within the treatment will be discussed throughout this article and in a particular case. An understanding of individual differences makes psychoanalytic formulations, especially about the body, more accessible and actionable. Overlooking the contribution of individual differences to a child’s play and development has consequences for progress in treatment. Together, DIR and child psychodynamic therapy can most effectively integrate “psyche” and “soma” (Winnicott, 1949). The child psychodynamic therapist’s particular expertise, in such areas as countertransference enactments and unconscious meaning, crucially contributes to this integration.     

The Association Between Reflective Functioning and Parent–Child Relationship Quality

Research consistently links adult and infant attachment styles, yet the means by which attachment is transmitted is relatively elusive. Recently, attention has been directed to the psychological underpinnings of caregiver sensitivity—originally thought to be the mechanism of transmission—as indicated by caregivers’ ability to keep in mind children’s mental states when interpreting children’s behavior, or reflective functioning. Unfortunately for researchers, extant measures of reflective functioning are time-consuming and require extensive observation and coding. A self-report measure could help facilitate the study and assessment of reflective functioning in research and clinical settings. This study investigated the relationship between parental reflective functioning and multiple aspects of the parent–child relationship, by using a new, self-report measure of reflective functioning. Participants were 79 caregivers (M _age = 31.8 years) who completed self-report measures assessing reflective functioning, parent–child relationship characteristics, perceived rejection in early relationships, attachment anxiety and avoidance in current close relationships, depression, and substance use. The results indicated that reflective functioning is a strong predictor of parent–child relationship quality (i.e., parental involvement, communication, parent satisfaction, limit setting, and parental support), independent of other potential indicators. Findings support parental reflective functioning as a contributor to the quality of parent–child relationship and suggest that a parent’s capacity to reflect on the mental states of his or her child in parent–child interactions may provide a key target for interventions that aim to improve parent–child relationships.     

“Hall of Broken Mirrors”—Enactment in an Analytic Group of “Difficult Patients”

This article focuses on the transformation of dissociated self-states as a curative factor in an analytic group of “difficult patients.” Foulkes (1964) referred to the analytic group as a “curative hall of mirrors.” I would like to integrate group analytic theory with relational psychoanalytic concepts. I propose that when dissociated self-states are expressed in a group, this creates a “broken mirrors” experience that is sometimes expressed through enactment. I develop this idea, and argue that the group mirrors to the patient his image—distorted and defective—and forces him to cope with his “not me” states. I demonstrate, through three clinical vignettes, how dissociated states hinder the reflective space and create a “hall of broken mirrors” experience. I would argue that in a safe space, the patients’ “not me” states can be transformed, and the hall of broken mirrors can turn into a curative hall of mirrors.     

The primal scene and symbol formation

This article discusses the meaning of the primal scene for symbol formation by exploring its way of processing in a child's play. The author questions the notion that a sadomasochistic way of processing is the only possible one. A model of an alternative mode of processing is being presented. It is suggested that both ways of processing intertwine in the “fabric of life” (D. Laub). Two clinical vignettes, one from an analytic child psychotherapy and the other from the analysis of a 30 year‐old female patient, illustrate how the primal scene is being played out in the form of a terzet. The author explores whether the sadomasochistic way of processing actually precedes the “primal scene as a terzet”. She discusses if it could even be regarded as a precondition for the formation of the latter or, alternatively, if the “combined parent‐figure” gives rise to ways of processing. The question is being left open. Finally, it is shown how both modes of experiencing the primal scene underlie the discoursive and presentative symbol formation, respectively.     

Le modèle écoculturel: un cadre pour la psychologie culturelle comparative

The main goal of this article is to examine the epistemological foundations of the contemporary cross‐cultural psychology from a constructivist point of view. We argue for the necessity of heuristic paradigms like the eco‐cultural framework of John Berry. Such an approach can be considered as a systemic modelling of complex phenomena by a psychologist (e.g., the relations of “mind‐brain‐culture” as well as their development). At the individual level, we argue the necessity to surpass the classic distinction between competence and performance. Competences are differentiated here as “intuitive representations” (or elementary mental functions) and “reflective representations” (or superior mental functions). Intuitive and reflective representations remain at the origin of both behaviour and performance. Such systemic conception allows the theoretical possibility of a “relativist constructivism” that could be more suitable than the “absolutist constructivism” proposed by Jean Piaget.     

Mothers' and Fathers' Gender-Role Characteristics: The Assignment of Postdivorce Child Care and Custody

Adults (151 female, 130 male; 17.4% African American/Black, 48% Caucasian, 22.8% Latino/Hispanic, 11.7% “other”) assigned postdivorce parental care and custody for four combinations of traditional/nontraditional mothers and fathers described in vignettes of divorcing parents. Parental gender characteristics influenced the assignment of parental care and child custody to divorcing mothers and fathers described in the scenarios and interacted with child gender. Across scenarios, female participants assigned more parental care and custody to mothers than did male participants. When feminine qualities were paired with masculine qualities, greater custody was assigned to the parent described with feminine characteristics (whether a father or mother) than when that parent was described with masculine characteristics. The role of feminine gender characteristics for child custody and care was discussed with regard to maternal primacy and possible changes for father involvement in the aftermath of divorce.     

Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations

Ecosystemic structural family therapy (ESFT) is a systemic, strength-based, and trauma-informed family therapy model that has evolved from structural family therapy (SFT; Minuchin in Families and family therapy, Harvard University Press, Cambridge, 1974). ESFT is an evidenced-based family therapy approach designed to intervene with families of children who are experiencing behavioral health problems and are at the risk of out-of-home placement. In this article we review the theoretical, applied, and empirical evolution of ESFT relative to extant SFT models. ESFT is based on the fundamental assumption that child, parental, and marital functioning are inextricably linked to their relational environment. Five interrelated constructs guide ESFT therapists in their understanding of clinical problems: family structure; family and individual emotional regulation; individual differences (e.g., historical, biological, cultural, developmental); affective proximity; and family development (Gehart 2010). ESFT has an extensive evaluation history dating back to the 1980s involving over 4,000 families in 39 different sites. While ESFT is considered evidence-based, it might be more consistent with “Practice-Based Evidence” given its long, extensive, and successful, history in the child mental health system in Pennsylvania.     

To Analyze or Not to Analyze: The Treatment of a Severely Disturbed Four-Year-Old Boy

This article summarizes the treatment of a severely disturbed four-year-old boy who represents the widening scope of child analysis—a boy whose exposure to an array of traumas undermined his ego development, distorted his object relations, and interfered with his developmental progression. Earlier generations of analysts would have viewed such a child as possessing too many ego deviations or deficits to be considered analyzable. Such traditional ideas about analyzability are at odds with more recent research, however. Thus, Fonagy's and Target's (1996 Fonagy, P.. and Target, M. 1996. Predictors of outcome in child psychoanalysis: A retrospective study of 763 cases at the Anna Freud centre. J. Amer. Psychoanal. Assn., 44: 27–77. [PubMed], [Web of Science ®] , [Google Scholar]) research found child analysis to be the optimal treatment for children with severe and complex psychopathology. This article presents analytic material that supports this research and demonstrates (1) that severely disturbed children are analyzable and capable of deep and meaningful change, (2) that early intervention is imperative, (3) that an analytic framework involving four or more sessions per week is essential in containing and regulating affect, (4) how functioning as a developmental object helps build the necessary mental structures to experience conflict, (5) that serving as a developmental object does not have to preclude the development of transference or a psychoanalytic process, and (6) that the analyst's gender can play an important role in promoting development and facilitating treatment.     

A Pattern-recognition Theory of Search in Expert Problem Solving

Understanding how look-ahead search and pattern recognition interact is one of the important research questions in the study of expert problem solving. This paper examines the implications of the template theory (Gobet & Simon, 1996a), a recent theory of expert memory, on the theory of problem solving in chess. Templates are “chunks” (Chase & Simon, 1973) that have evolved into more complex data structures and that possess slots allowing values to be encoded rapidly. Templates may facilitate search in three ways: (a) by allowing information to be stored into LTM rapidly; (b) by allowing a search in the template space in addition to a search in the move space; and (c) by compensating loss in the “mind's eye” due to interference and decay. A computer model implementing the main ideas of the theory is presented, and simulations of its search behaviour are discussed. The template theory accounts for the slight skill difference in average depth of search found in chess players, as well as for other empirical data.     

THINKING ABOUT VOICES: A CLINICAL FRAMEWORK FOR USING PSYCHOANALYTIC PSYCHOTHERAPY TO RECOVER A NON-PSYCHOTIC SELF-REPRESENTATION IN A SCHIZOPHRENIC PATIENT

In this paper, I have reported how a woman with a long history of paranoid schizophrenia was able to use psychoanalytic psychotherapy in the NHS to work through a delusional belief of having her father's child. As a result of the therapy she was able to recover a reflective function and to represent herself, again, as a non-psychotic person. I have described the clinical framework of the therapy as based on the psychodynamic developmental therapy and the mentalization model, as developed by Fonagy and Target (1996 Fonagy, P and Target, M. 1996. Playing with reality: I. Theory of mind and the normal development of psychic reality. International Journal of Psychoanalysis, 77: 217–233. [PubMed], [Web of Science ®] , [Google Scholar]), which posits that the development of a core or psychological self is not a given and can occur only through early object relationships with a caregiver who enables the child to integrate two modes of functioning, the psychic equivalence and the pretend modes. If the care-giver is abusive or unable to acknowledge or think about a piece of reality the child will not be able to do so on her own and, as a result, will experience the unthinkable thought in a psychic equivalence mode. In the clinical setting, the role of the therapist is, first, to acknowledge the reality of the patient's internal world and eventually enable her/him to think about the unthinkable thoughts.

I have emphasized, also, the technical importance of balancing interpretation of unconscious strivings with ego-supporting communications.

I propose that this framework can be used to enable some people suffering from severe and incapacitating mental illness to lead more satisfactory and fulfilling lives through the exploration of delusional formations and the recovery of a non-psychotic part of their selves.     

The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years

This article presents a longitudinal study of the development of “family alliance” from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self‐reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: “high stable” (n = 19), “high to low” (n = 10), and “low stable” (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family‐level and individual‐level variables for understanding individual differences in the social and cognitive development of children.